| NPI | 1649701517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 6238) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY 2872) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2021-02-08 |